Park Ah Young, Son Eun Ju, Han Kyunghwa, Youk Ji Hyun, Kim Jeong-Ah, Park Cheong Soo
Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
Eur J Radiol. 2015 Mar;84(3):407-412. doi: 10.1016/j.ejrad.2014.11.019. Epub 2014 Nov 27.
The purpose of this study is to validate the usefulness of shear wave elastography (SWE) in predicting thyroid malignancy with a large-scale quantitative SWE data.
This restrospective study included 476 thyroid nodules in 453 patients who underwent gray-scale US and SWE before US-guided fine-needle aspiration biopsy (US-FNA) or surgical excision were included. Gray-scale findings and SWE elasticity indices (EIs) were retrospectively reviewed and compared between benign and malignant thyroid nodules. The optimal cut-off values of EIs for predicting malignancy were determined. The diagnostic performances of gray-scale US and SWE for predicting malignancy were analyzed. The diagnostic performance was compared between the gray-scale US findings only and the combined use of gray-scale US findings with SWEs.
All EIs of malignant thyroid nodules were significantly higher than those of benign nodules (p≤.001). The optimal cut-off value of each EI for predicting malignancy was 85.2kPa of Emean, 94.0kPa of Emax, 54.0kPa of Emin. Emean (OR 3.071, p=.005) and Emax (OR 3.015, p=.003) were the independent predictors of thyroid malignancy. Combined use of gray-scale US findings and each EI showed elevated sensitivity (95.0-95.5% vs 92.9%, p≤.005) and AUC (0.820-0.834 vs 0.769, p≤.005) for predicting malignancy, compared with the use of only gray-scale US findings.
Quantitative parameters of SWE were the independent predictors of thyroid malignancy and SWE evaluation combined with gray-scale US was adjunctive to the diagnostic performance of gray-scale US for predicting thyroid malignancy.
本研究旨在通过大规模定量剪切波弹性成像（SWE）数据验证其在预测甲状腺恶性肿瘤方面的实用性。
本回顾性研究纳入了453例患者的476个甲状腺结节，这些患者在超声引导下细针穿刺活检（US-FNA）或手术切除前接受了灰阶超声和SWE检查。回顾性分析并比较了甲状腺良恶性结节的灰阶表现和SWE弹性指数（EI）。确定了预测恶性肿瘤的EI最佳临界值。分析了灰阶超声和SWE预测恶性肿瘤的诊断性能。比较了仅灰阶超声检查结果与灰阶超声检查结果联合SWE检查结果的诊断性能。
甲状腺恶性结节的所有EI均显著高于良性结节（p≤0.001）。预测恶性肿瘤的各EI最佳临界值分别为：平均弹性模量（Emean）85.2kPa、最大弹性模量（Emax）94.0kPa、最小弹性模量（Emin）54.0kPa。Emean（比值比3.071，p = 0.005）和Emax（比值比3.015，p = 0.003）是甲状腺恶性肿瘤的独立预测因子。与仅使用灰阶超声检查结果相比，灰阶超声检查结果与各EI联合使用在预测恶性肿瘤方面显示出更高的敏感性（95.0 - 95.5%对92.9%，p≤0.005）和曲线下面积（AUC）（0.820 - 0.834对0.769，p≤0.005）。
SWE的定量参数是甲状腺恶性肿瘤的独立预测因子，SWE评估与灰阶超声联合使用可辅助灰阶超声预测甲状腺恶性肿瘤的诊断性能。
